Lecture 10: End of Life Care and Death

Question 1

What are the 3 themes of a “Good” death?

Answer 1

Control
Autonomy (one’s has free will)
Independence (one doesn’t need resources from another)

Question 1

What are the 12 principles of a good death?

Answer 1

To have control over:
* what happens
* pain relief and other symptom control
* where death occurs (ex. home or elsewhere)
* who is present and who shares the end
* To be afforded dignity and privacy
* To be able to issue advance directives which ensure wishes are respected
* To have time to say goodbye, and control over other aspects of timing
* To be able to leave when it is time to go, and not have life prolonged pointlessly
* To know when death is coming and to understand what can be expected
* To have access to:
Information and expertise of whatever kind is necessary.Any spiritual or emotional support required. Hospice care in any location, not only in hospital

Question 2

What ascept of the “Good death” model, does it miss?

Answer 2

Model misses spiritual
aspects

Question 3

What are the two problem with hospital deaths?

Answer 3

Low patient-physician communication and knowledge of wishes
ICU can be traumatic and stressful for patient and family

Question 4

Where do most EoL patients die?

Answer 4

Homes - 19%
* Other private houses (2.4%)

Hospitals - 66.5%

Palliative Care
* Hospice (4.3%)
* Other communal establishments (7.8%)

Question 5

4 Studies that show that the timing of death is associated with hoildays:

Answer 5

Harvest moon festival (Chinese American women) (Phillips & Smith, 1990)
Passover (Jewish Men, no effect for Jewish women) (Idler & Kasl, 1992; Phillips & King, 1988)
Christmas and Easter (both men and women) (Idler & Kasl; 1992)
Sharp increase in deaths the month after January 1, 2001 (Sinard, 2001)

“a likely contributing factor was desire of patients to live into the next century … these data suggest a role for the patient’s state of mind in postponing his or her own outcome”

Question 6

Mortality is higher during first (BLANK) months after the death of a spouse

Answer 6

6

Question 7

Levy et al. (2002) Self perception of aging, will to live

Answer 7

Sample: Longitudinal 23 year study
IV: Self perception of aging, will to live
DV: mortality
Results: More negative views of aging (aka lower personal self-perception of aging) was associated with decreased mortality (early deaths)
* 7.5 difference of life span
* Will to live was a meditating factors
Contribution to Psychology: shows that Factors of positive mood, and agency (Will to live) may have an impact.

Question 8

What is clinician-administered MAID?

Answer 8

A physician/nurse practitioner directly administers a substance that causes death

Question 9

What is self-administered MAID?

Answer 9

A physician/nurse practitioner provides or prescribes a drug that the eligible person takes themselves to bring about their own death

Question 10

What is the 6 Eligibility conditions of MAID?

Answer 10

Eligible for government-funded services (not eligible to visitors)
18 years old and mentally competent
Have a grievous and irremediable medical condition
Make a voluntary request for MAID that is not the result of outside pressure or influence
Give informed consent to receive MAID
You do not need to have a fatal or terminal condition to be eligible for medical assistance in dying.

Question 11

What are the 3 Grievous and irremediable medical condition criteria?

Answer 11

• have a serious illness, disease or disability (excluding a mental illness until March 17, 2023-postponed to 2024)
• be in an advanced state of decline that cannot be reversed
• experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable

Question 12

What are the 3 points about belief in life after death?

Answer 12

• related to better mental health (ex., anxiety, depression, obsession-compulsion)
• unrelated to organized religious activity (ex., religious attendance/activity)
• positive relationship between prayer and symptom severity (except for depression) (Flannelly et al., 2006)

Question 13

What did Shah et al., (2015) do to find their results? What were the results?

Answer 13

Topic: public attitudes on brain death and vital organ transplantation
Meta-analyses (43 articles, 18603 participants)
Found 3 main key issues generally not understood
1) uncontested biological facts about brain death
2) The legal status of brain death
3) Organs are procured from brain dead patients while their hearts are still beating and before their removal